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Operations are undertaken (1) to correct the fixed deformity when present; (2) to improve the viagra kostenlos muscle function, and (3) to secure stability of useless joints. 1. The correction of fixed deformities has already been discussed. 2. The improvement of muscle function is usually accomplished by transplanting the tendon of a sound muscle for that of a paralyzed one. It is best to defer this operative procedure for a period of at least one or two years after the onset of the paralysis as within that time all spontaneous recovery of function should have taken place. Good function in the limb operated upon can be expected in about six months. One must always bear in mind that massage, muscle training, active and passive motion of the tendon, free from body weight, should invariably precede subjection of the joint to the heavier strain of the body weight. 3. To secure the stability of flail and other more or less useless joints: This viagra kostenlos is usually done when so many muscles are paralyzed that trans- plantation cannot be undertaken. Arthrodesis or the production of artificial ankylosis, is one of the methods used. It is of greatest service at the ankle joint where it may serve to fix the foot at a right angle to the leg. Arthrodesis should not be done in children under fourteen years of age, where the knee cannot bear the body weight, or on the knee in children on account of the interference viagra kostenlos with the epiphyseal growth. Astragalectomy, as advocated by Whitman, has been performed in para- lytic viagra kostenlos calcaneous with excellent results. Osteotomy in some instances, especially in extreme viagra kostenlos deformi- ties in the adult, has proven useful in overcoming resistant distortion. The silk ligament viagra kostenlos suspension operation as advocated by Bradford and Allison and reported upon favorably by Ryerson, is es- pecially of value in foot drop. Nerve grafting, as advocated by Spitzi and oth- ers with the aim of viagra kostenlos restoring muscular power in paralyzed muscles by uniting the inactive nerve with one which is still active, has been performed with encouraging results but the operation is still in the experimental stage. In conclusion it may be said if a case of anterior poliomyelitis is seen early it is possible by me- chanical means as splints, braces, manipulation, muscle training and massage to prevent the occur- rence of contractures. In the later stages, we have at our disposal means such as manipulation, tendon transplantation, tendon fixation, arthrodesis, and various bone operations to entirely correct some and improve probably the majority of the deformi- ties that are usually met with. I wish to thank Dr. S. Kleinberg for his kind suggestions. 1051 BosTO.v Road. ECZEMA AND THE BULKLEY RICE DIET. By F. red cialis viagra TWEUDELU M.D., SUMMIT, N. J. The etiology of eczema is very imperfectly under- stood by the average general practitioner; this is due to the teaching of the textbooks, which give viagra kostenlos any number of "predisposing and exciting causes," but no definite proofs. Six cardinal symptoms are popularly supposed to be ahvays present, namely erythema, itching, moisture, crusts, fissures and in- filtration. For many years I have been a sufferer from a form of eczema, seldom recognized by the general practitioner and not always by the dermatologist. The first sign was itching and sweating between the toes, sometimes followed a day or two later red cialis viagra by the appearance of a vesicle, which itched inces- santly. Most vesicles, when opened, will discharge their contents for awhile and then dry up. Not so, however, in this variety. When opened, they oozed for some time, then closed up again as if they had never been touched. Next the vesicles formed between the fingers. These persisted for months, accompanied by intense itching. Opening up the vesicles in the hope of assisting them to dry up did not improve matters, for they discharged for a long time or formed new walls. For nearly twenty years I have been afflicted with this annoying condition. Curiously enough, these vesicles appeared and usually persisted throughout the warm months of the year. On the other hand, during the winter months, the vesicles disappeared, and were replaced by fissures, usually on the tips of the fingers just below the nails, at other times on some other part of the hands. The first sign was a small painful point, like the mark left after using a hypodermic needle. The ne.xt day the skin had split open about V2 mm. wide, and three or four mm. viagra kostenlos long. The fissure did not itch, but was viagra kostenlos very painful. In October, 1914, the vesicles spread to the palms and to the dorsum of the hands, with the forma- tion of crusts, fissures, and a serous discharge. There was no rash on any other part of the body. It was now high time to see a dermatologist and I decided to consult Dr. L. Duncan Bulkley of New York. On October 29, after taking a careful history, and examining me thoroughly. Dr. Bulkley put me on three red cialis viagra meals a day, consisting of nothing but hot boiled rice, bread and butter, and viagra kostenlos water. My weight was then 185 pounds. I was advised to examine a specimen of my urine and found that it showed an excess of indican. It is well to mention here that I was not only a red cialis viagra great meat eater but also a heavy eater and that I did not get enough exercise in proportion to the